Review of Joseph Lichtenberg's
Craft and spirit

Tony Verner

Book review. Lichtenberg, J.D. (2005). Craft & spirit: A guide to the exploratory psychotherapies (Vol. 20 in the Psychoanalytic Inquiry Book Series). Mahwah, NJ: Analytic Press. 216 pp. US$45. ISBN 0881634336.

Craft and spirit is 'written to inform not only patients contemplating intensive psychotherapy but also experienced therapists and those in training' (p. vi). I am not sure that many patients would have the commitment to read it all the way through, but clearly this is a valuable book, especially for psychoanalytically-informed therapists. It has a strong practical focus, with the 10 chapters dealing with each of the 10 principles or guidelines of technique set out more briefly in Lichtenberg, Lachmann and Fosshage's 1996 book The clinical exchange. In that book, one nine-year analysis of Lichtenberg's patient, Nancy, was given comprehensive coverage, with a very useful lengthy transcription of interactions between patient and therapist. This showed us that experienced contemporary psychoanalysts use many different interventions than classical interpretation. In Craft and spirit there are 30 cases (of Lichtenberg's, Lachmann's and Fosshage's) actually described, but with less lengthy transcriptions. (I would be interested to know by what method the transcriptions were obtained.) There is also less focus in Craft and spirit on the five motivational systems enunciated by Lichtenberg and his colleagues in previous publications.

Craft and spirit is well written and a delight to read. Consonant with his theory, Lichtenberg is quite transparent about how he actually works, triumphs and stumbles included. There are some wonderful examples given of what Lichtenberg and his colleagues describe as "disciplined spontaneous engagements" on the part of the therapist, which certain more orthodox psychoanalysts would blanch at. This willingness to be flexible, innovative and pragmatic in his technique, in empathic resonance with the patient, is the hallmark of Lichtenberg. Lichtenberg is integrative in his approach, diverging in many significant ways from classical ego-psychological and even self-psychological technique and theory. In addition to these traditions, he draws from infant research, attachment theory, neurophysiology, systems theory, intersubjectivity and relational psychoanalysis. A useful list of those works which have influenced Lichtenberg's thinking is contained in the Notes section of this book. I particularly recommend the two autobiographical articles cited there, as well as Teicholz' interview of Lichtenberg in the Summer 2004 edition of Self Psychology News (http://www.psychologyoftheself.com/newsletter/2004/teicholz.htm).

An innovation of this book is Lichtenberg's combining under the rubric of 'exploratory, investigative or intensive psychotherapies' psychoanalysis and psychoanalytic psychotherapy. This amalgamation, he implies, is something that would not have been possible 25 years ago when he wrote his first book The talking cure: A descriptive guide to psychoanalysis. Both psychoanalysis and psychotherapy now both 'involve two interactive subjectivities where therapists must sense themselves, and be sensed by their patients, as fully and emotionally involved in the treatment' (p. viii). Lichtenberg sees therapists as now 'more on stage'. There is greater involvement and transparency, but this, he points out, must not be allowed to interfere with the traditional freedom of exploration on part of the patient. 'The biggest difference between analysis and psychotherapy lies not in the principles of technique used, but in the opportunity provided by the frequency of the sessions and an open-ended mutual commitment' (p. vi). (Lichtenberg does not touch upon the extensive literature of brief or time-limited psychoanalytic psychotherapy; nor, unlike Wachtel or Mardi Horowitz, the overlaps between analytic and non-analytic psychotherapies.)

Another change that Lichtenberg believes has occurred over the last 25 years is that traditional 'ideal-for-analysis patients' have proved to be extremely rare and analysis has become increasingly sensitive to personality or characterological problems and the many impediments that limit free association. This, in his view, creates a need for fresh consideration of technical guidelines. Lichtenberg, who tends not to conceptualise cases in terms of DSM-IV diagnoses, contends that most patients bring to therapy, backgrounds of insecure attachment (preoccupied, anxious-resistant, disorganised) and serious concerns about safety and being again traumatised.

Lichtenberg sees effective psychotherapy as being a balance between rule-based consistency (which provides a frame of safety for the patient) and a spontaneity on the part of the therapist which helps provide an aliveness, creativity and depth to the co-constructed narrative of the patient's life. A sense of safety, a secure base, leads to more open and direct communication, and vice versa. "Progress in therapy combines therapists being guided by their intuitively sensing the likely positive impact of an intervention and being free on occasion to risk an intervention outside the known safety zone.... the art of conducting a successful exploratory psychotherapy lies in listening, understanding, and articulating within the boundaries of a predictable intersubjective field of safety while remaining open to humour, novelty, and improvisation" (pp. 181-182). This is therapy as a highly skilled craft.

An important concept for Lichtenberg is what he calls 'a spirit of inquiry'. This is, I presume, more fully enunciated in his previous book with Lachmann & Fosshage (2002) A spirit of inquiry. The term is defined in the present book as "the ineffable something more than the craft and the doing of listening, understanding, and interpreting. It is the humanist trend that combines the healer's altruism with a therapist's approach to exploration through sensing into another to gain a depth of knowledge of the other, the self, and the emergent experiential world they create together" (p. xiii).

Lichtenberg's 10 guidelines for exploratory psychotherapy are:

1. Arrangements that establish a frame of friendliness, consistency, reliability, and an ambiance of safety
2. Systematic application of the empathic mode of perception - 'sensing into the mind-states of others' (and of the self)
3. *Discerning a patient's specific affect to appreciate his or her experience; and discerning the affect experience being sought to appreciate the patient's motivation
4. 'The message contains the message' (this is contrasted with the view of classical psychoanalysis that the true message of the patient is always concealed). Therapist and patient open communication to its fullest revelation
5. Filling the narrative envelope (to better grasp the patient's narrative, the therapist asks 'who, what, where, when, and how' questions of events)
6. *'The wearing of attributions', i.e. the therapist accepts the reality of the patient's experience of the therapist
7. *Joint construction of model scenes - bringing the theatre of the mind onto the patient-therapist stage. The elaboration of one or more model scenes, metaphors or schemas integrates disparate aspects of the patient's experience, past and present
8. *Aversive motives (resistance, reluctance, defensiveness) are a communicative expression to be explored like any other message - what are the messages that a patient does not want the therapist or himself/herself to know?
9. Three ways in which therapists intervene to further the therapeutic process:
   1. Most frequently, the therapist's interventions are based on empathic listening and are presented from the patient's point of view
   2. Illuminating a recognisable pattern, or communicating feelings, appraisals, or impressions from the therapist's own perspective
   3. *Disciplined spontaneous engagements
10. Following the sequence of interventions and the patient's responses to them to evaluate their effect.

Conclusion:

Lichtenberg is both a practicing psychoanalyst and psychotherapist. This is far from rare, but it is still unusual to have one of the major figures who writes regularly in the top psychoanalytic journals focusing in depth on the common reality of psychoanalytic psychotherapy practice. (Wallerstein is another major figure who immediately comes to mind. The field of self psychology has been blessed with other notable exceptions: e.g., Basch and Ringstrom). It is over 50 years since Alexander, Gill and others bravely brought the skeleton of psychoanalytic psychotherapy out of the closet into the pages of the Journal of the American Psychoanalytic Association (1954). Since then the bastard son, the shameful mutant, has morphed into many strapping even dominant offspring. 'Dominant' in the sense that psychotherapy, both extensive and brief, has become far more widely practised and acceptable to the vast majority of psychotherapy patients. It is evident that most of those trained as psychoanalysts are conducting relatively few 'psychoanalyses', according to traditional criteria such as frequency and purity of technique (free association, therapist abstinence/neutrality/anonymity, pure interpretation of transference or resistance, and so on). Many 'true' psychoanalyses appear to be carried out on trainee psychoanalysts or other therapists. Despite this, what I observe in my little part of Australia, amongst the beleaguered few who read psychoanalytic texts, is a sort of benighted worship of ancestors, involving what appears to be a huge gap between what we discuss in our seminars and reading groups (disputing how many angels fit in the eye of a needle) and actual therapy practice.

Presumably there will always be a need, and an ability to pay, by some patients for psychoanalysis, traditional or contemporary. Psychoanalysis still remains by far the richest and most insightful paradigm explaining human function, dysfunction and psychological healing. It has therefore much to offer trainee therapists of today, be they psychiatrists, psychologists, family therapists or counselors. Psychoanalysis' future lies with seeking interdigitation or ecumenical dialogue (not capitulation) with the dominant paradigms in these fields, namely neurobiology, CBT, systems theory and constructivism. Psychoanalysis ignores these fields, and the attempts to resolve conflicts between them through research, at the peril of increasing marginalisation.

Joseph Lichtenberg, at an age when many are lured by the sirens of resignation, is still courageously and energetically leading the way towards more fruitful integration and the amendment of psychoanalytic theory to more closely resemble psychotherapy practice. He is an inspiration to many of us at the farther reaches of the world.

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Tony Verner is a psychodynamically-informed psychologist, member of the Brisbane Psychoanalytic Self Psychology Group, who is Program Leader for relationship counselling and education in Relationships Australia Queensland, a community-based counselling organisation. He is an ex-diplomat, university administrator and art gallery owner. He also has degrees in literature, economics, administrative studies and clinical hypnosis. (tverner@relateqld.com.au).

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